Japan and Italy by contrast seem to do extremely well: what do they have in common ? Maybe they have so far resisted making profits from the sick ?

Also in the report one can find a more interesting aspect concerning health in the US: people below the age of 50 are doing really bad compared to other nations. By contrast older and especially older than 75 do much better than other nations. Maybe because they retire on Cote d'Azure and rely on the French health system, a way better one ?

In Japan, there is a vast employee insurance program which deducts from your salary at most corporations. This program covers 90% of health care costs, you cover the other 10%. The scale slides as treatments get more expensive (you pay closer to 1% for major life-saving operations.) Consumers become smart shoppers of their health care yen. That is the key, not government funding.

Why do most of the comments fight the simple facts laid out in the graph? This is why nothing gets done; instead of talking about what to do about the situation, we bitterly argue about whether or not it actually exists. Change is good, and we Americans need to stop fighting it.

Yes, after living in The Netherlands for 32 years, in the US for 18 years, in England for 2, in Germany for 10 years and now back here for 13, the pattern is clear, nothing worthwhile gets done, ever. Worthwhile is truly helping and steering the population in the right direction. Freedom does not exists, we all have obligations to each other. American only flap their lips when it comes to gun control or healthcare. (and I believe it will never be solved, there is no ethical will)

I appreciate your article on health costs. Unfortunately, it ignores the consequences of the increasingly large gap between rich and poor, and the health problems associated with that divide. Further, not only the very poor, but the struggling population defining itself as middle class, has fallen victim to the economic disparity and is often unable to afford health care.

I assume that the situation you are alluding to, is mostly a USA phenomenon. Am I correct? Universal health insurance would take care of of most of the problem of affordability for the poor and the struggling middle class as every advanced country but the USA has found out in the last 50 or so years.

Yes, I am referring to the USA. I agree that universal health care would take care of most of the problem, though I doubt that we will see it in America during my lifetime. Resistance by the entrenched interests (insurance companies that would go out of business, big pharma, some areas of medicine...the list goes on) which profit from the present situation would almost certainly preclude any form of single payer health care system. Lamentably, I have not yet seen an alternative to single payer systems that makes much sense, and have limited faith that the current health care act will solve our problems.

Interesting hypothesis, but the fact is that in the US health care is actually universally available. How it gets utilized and paid for is the real mess.
A more puzzling issue in the US is that a significant portion of the population with access to quality health care chooses not to use it until their condition can no longer be ignored,or sometimes even treated, exponentially increasing the cost of their care. Combine that with increasingly appalling dietary choices (Only in the US are we faced with obesity being "epidemic among the poor.") and health care costs multiply again, before even considering the effectiveness of delivery.
Could it be that, like many other uniquely American "crises," from finance to political choices, the root cause here as well is the dismal decline of the US education system?

Health care is only "universally available" if you define it as having access to an ER, and even that depends on where you happen to live (big cities do a lot better than reservations for Native Americans). If a broader definition is adopted (good primary care, access to specialists as needed, etc) universal availability is a harder case to make. I agree, however, that utilization and financing are at the root of many of the problems. I also concur with the idea that people often do not avail themselves of care when it is available (colonoscopies, etc) and that American dietary choices are often appalling. I am not so sure that the root cause is found in a declining educational system, there just seem to be too many other factors involved...politicians protecting their own interests, corporate influence (but I repeat myself), prevalent economic conditions, etc. I often feel as though we blame the educational system for our own failings: poor parenting, disinterest, disengagement from our children, a willingness to blame teachers for our failure to sit down and help educate our children (I believe it is called homework) or at least get them to school, and an increasingly stratified society.

Of course if we measured White America it would not look so bad.
Odd it took Obama to try the long road to redress the heritage of a Christian democracy based on slavery and now illegal Mexicans to do the nasty dangerous and low paid no medical perks jobs

By maintaining their current health care system (for profit health insurance, for profit care delivery system, etc), America wastes 6/7% of their GDP when compared to Germany, for example, or any other country for that matter and has not much to show for it. That is more than their Defense budget. Maybe, it is safer for the rest of us that way.

America only cares about businesses. It's social programs are corporate welfare programs. The Obamacare was for the benefit of the healthcare industry (including mandates), as was Bush's prescription drug program (Medicare part D).

And what's good for the healthcare business? -- more sick people means more customers. Outcome is second. What matters is giving patients more unnecessary procedures to accrue more healthcare "profits" (which are costs to individuals and the economy). The only way to resolve this by a power structure change in Washington where people matter more than companies; which won't happen so long as there is lobbyism, campaign donations (bribing), and revolving doors to private companies in exchange for national treaures.

You can thank the lawyers for unnecessary procedures. Everytime a doctor doesn't do a test and there is a bad outcome, they get sued. So they answer is unnecessary tests. The only thing Obama care has done is force doctors to retire as they are fed up with the bureacracy and not being able to practice medicine without some govt watchdog butting in with a new form. The paperwork required now is ridiculous. Obamacare is destroying on medical care and good luck finding a doctor in the future.

I'd recommend reading "The Healing of America", T. R. Reid, Penguin Books, 2009. This report simply confirms the outcomes presented by Reid. Reid clearly explains the dysfunctional delivery system(s) we have in the U.S. If we would only open our eyes to what works in the rest of the world, we might learn something. Alas, our politics, rooted in ideology rather than fact, doesn't seem capable of doing this.

Careful with stats. Do all the stats from the countries use the same measuring criteria? In france, infant mortality in preemies are only counted if the reach a certain preemie term. The US takes the sickest from all countries and treats them and counts them. So US stat may not be comparable to other countries.

Part of the problem is probably related to the idea that we Americans are overweight, over-medicated booze hounds who drive too fast. It might also be related to a lack of emphasis on preventive care. But there is no doubt in my mind that a lack of cost and quality information is also to blame.

Having worked with, analyzed, sliced and diced US health care procedure and claims data, it is apparent there are significant cost differentials for roughly the same procedure delivered with the same quality of care but performed at one facility versus the next, such as a colonoscopy performed by the same physician at a local hospital versus the facility literally across the street!! The cost differential can be 3-5 times as much, easily.

Instead of arguing about single payor, public vs private blah blah blah, we should be advocating greater transparency in cost information. If consumers knew they could pay substantially less to get the same outcome, they would probably do so. The data exists for transparency, but its not in the best interests of health care providers to make it available to the consumer. It is remarkable to me that we think nothing of looking up cost and quality information on a 50-inch flat panel TV, and completely ignore the concept when it comes to our own health care.

Good idea, but you cannot do this when you are really sick, you are stuck with where you are delivered. Lab costs are not specified beforehand, the lab report is ordered by the provider. In fact, the providers are money grabbing little medical dwarfs who have no idea how to serve as they are supposed to serve. That is different in other countries where the government keeps the providers i check.

I agree that critical and urgent care will always be the exception, and rural populations are more limited in options. However, single payor isn't going to fix the price problem in any situation. The "medical dwarfs", as you call them, are extremely clever in how they obfuscate the billing of health care procedures and justify the underlying costs. We don't need a single payor to mandate price and quality transparency, but we do need a law, just like other laws that mandate disclosure of price, just like other things you buy.

If I look at how the government is snowed when it comes to defense spending and DOD subcontracting prices, I can only assume that we would have the same problem with health care in a govt-sponsored single payor scheme.

Of course this requires a change in consumer behavior. We don't buy cars like this, and we certainly don't buy the under-body coating that the car salesman recommends without asking about price, or wondering if we even need it in the first place.

Well put, however I remember the phrase used in a discussion of having the consumer make the choices of care, which would supposedly drive the cost down. The writer at that time said: The only driving the consumer will do is drive to the recommended treatment center.
Example, I was recommended to undergo the Helio360 treatment since I have/had Barrett's syndrome due to GERD. The referring doctor recommended a certain specialist. His reasoning was that this specialist had done the procedure about 800 times and his success rate was very good. I also trust the recommending physician.
Would I go and find someone else who may be cheaper? Would I ragg the specialist to lower the price? The specialist turned out to be very informative, dry sense of humor, explained all that was happening. Medicare paid. Is it worth it? I rather not die from esophagus cancer, although I will die and I will not hang around longer than necessary. (Where is my freedom of choice here? In The Netherlands I can go to a doctor and say: enough is enough, end my life).

Studies like this ignore the basic truth of health care in the US by aggregating data for the entire country. To understand these numbers, the U.S. must be viewed as a number of third-world nations cohabitating with a first world nation.
To compare the U.S. with relatively homogeneous societies gives generally misleading results.
It would be more productive to focus on the disparity of health in the U.S. rather than on general comparisons.
As a research professor warned us, the "average" human has one ovary and one testicle.

For $10 per citizen per year, we can employ simple scientifically proven interventions that will decrease morbidity and mortality, improve health, and prevent illness.
It would increase average life expectancy from 3-6 years, and for instance, can allow the US leap ahead of #1 Japan.

We need a new model. In Western Societies, the new diseases as everyone lives longer, are CHRONIC ILLNESS. The diseases are NOT CURED, BUT MANAGED. And it requires small behavior changes and small amounts of medication for life.

1.) Ban Tobacco Products, the leading Preventable cause cancer deaths, heart attacks and strokes. It would cost nothing in health care but would literally overnight vault the US life expectancy over the #1. Japan.

2.) Tax Alcohol extremely regressively to the point that consumers have to hurt to make a purchase. They will value that little sip of brandy or Chardonnay even more. Make bottles much smaller at around 100 ml. Like a Coca Cola at the turn of the century: medical tonic amounts. Yes people can drink, but moderation(less than two drinks) is best.

3.) Simple cheap ASPIRIN dramatically cuts rates of Strokes, Heart Disease and now recently proven in a longitudinal study, reduces Cancer death rates by 20%! Put ASA in the water supply–-it would be cheaper than fluoride.

4.) Water Born Oral VACCINES. Up to 30% of parents do NOT believe in the value of vaccinations and many act on this belief. Utilize water borne vaccinations in the water supply, such as the oral polio Sabin Vaccine. Put Folate in H20 to prevent neural tube defects in fetuses.

5.)Put STATIN drugs in the water supply. Heart disease is declining for the first time in history. It is due to widespread use of effective anticholesterol drugs known as ‘statins.’ ie. Lipitor. High cholesterol is endemic and contributes to strokes and heart attacks. Just about everyone benefits from lower cholesterol.
6.) PROZAC to decrease Dysfunctional Behaviors and improve Mental Health. Far more common than crime is non-criminal personal dysfunctions. Up to 40% of Americans will experience a diagnosable mental illness in their lifetime including Depression, Alcohol abuse, illicit Drug abuse, Anxiety disorder, PTSD, Obsession-Compulsion, Eating disorders. Half of these will remain undiagnosed. And love ones suffer by enduring the mental ill relative like an affliction. Virtually all these maladies would benefit from Prozac type drugs which increase brain serotonin neurotransmitter. It is a vital tool in psychiatry: ‘Vitamin P’. Put Prozac in the water supply and we will be less sad, less depressed and less dysfunctional. It will shrink dysfunctional behaviors, criminal behaviors, afflictions and addictions. It would save BILLIONS in the Criminal Justice System. Lead to more productive fulfilled citizens who are happier. Less alcohol and drug addictions. Less DUI, trauma and killing sprees.
7.) Perhaps an effective future drug to treat or prevent Diabetes or Obesity–put it in the water. We have a new Epidemic of Obesity never before seen in the history of civilization. All interventions have been stymied to reverse the epidemic. We have to be creative about how to address this problem.
8.) Restrict television broadcasts to 2 hours a night of quality programming from 8 pm to 10 pm. We get 24 hours of 1000 channels–98% is garbage programming. It would force Americans to find other more healthy forms of recreation like walking, exercising, reading and even talking with each other. We undersleep and spend 4-6 hours of waking hours watching TV.
9.) Make Supermarkets reflect a Vegetarian Diet. 80% of floor space for Produce. 10% for dairy. 10% for the meat department. Vegetarians live longer and are more active. We have to make it easier and more desirable to enjoy vegetables Likewise encourage walking, exercise, and activity.
10.) Milk-Based Nutrition/ Beverages. It may be that only intervention in the young, with increased Calcium intake, impact exercise leading to high bone density can prevent the inevitable epidemic of Osteoporosis. To increase calcium in young persons, make all flavored beverages and hydration drinks MILK BASED. A milk based Coca Cola. We will see taller, more active, healthier citizens. This will make a difference in the wide spread osteoporosis of the elderly. Your skeleton will thank you decades later.

This is a radically different way of thinking about Public Health, Medicine and Wellness. Desperate Times Call For Desperate Measures. Make Public Health medication an automatic feature by incorporating it into normal plumbing. Let people OPT-OUT by buying their own water and we will have 95% participation. We now have an OPT-IN system for medicine that is not working. Healthcare delivery is a complex problem requiring smart solutions, but sometimes solutions can be as simple as fluoridating water. We need a Fluoridation System for the 21st Century.

No one should mess with the water supply more than they already have. Many of your suggestions would be a violation of individual rights. We don't live in a socialist society yet. Obama is working on it. Your ideas take away the idea of free will and choice. Obesity is a choice. This govt feels that the health choices one makes should not be penalized by higher health costs. Obamacare introduces the idea of fairness. Unhealthy people don't have to pay more the healthy people for insurance. That only encourages bad behaviour. Restricting TV, forcing supermarkets to be vegetarian, forcing milk are all violations of individual rights and are not acceptable in the US. Obama would like to restrict freedom of choice except in abortions but until he does, US citizens make whatever choices they want,and will fight any efforts to tell them differently. BTW- a good number of US use wells for water. So your ideas are not feasible.

How people feel about WATER FLUORIDATION is a reliable indicator about how they suffer from Paranoid Disorders and Delusions.

See classic film, Dr Strangelove,
=> General Jack Ripper's philosophy on the Commie plot to fluoridate the water supply and contaminate our Precious Bodily Fluids.

Other things are perserverating complaints about the Gob'mint, taxes, prepping for the impending Apocalypse and Armageddon, and complaints that the Law wants to 'take ma' guns away'.
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Please see Item #6. above.
40% of the population has a diagnosable psychiatric illness. 10% suffer from Paranoid Delusions.
You need to seek professional help.

I believe you mean "the illusion of free will and choice."
And no, I am not talking about whether we really have a free will as biological beings, but about the policital / ideological aspect of this in complex modern USA.

Wow ... I don't even know where to start, but I will try. First, putting all of those drugs in the water supply is a very, very bad idea. Aspirin in water? What about people who already bleed easily? Suddenly, you are going to cause an epidemic of internal bleeding issues across the nation. Vaccines in the water supply? What about the people who are allergic to how they are made? Or shouldn't be getting them because they are already immune compromised? Prozac in the water supply? Do you really think giving everyone a selective serotonin reuptake inhibitor (SSRI), which often have extreme side effects, is a really good idea? And what about the people who don't drink water? Or, those who do, but drink a lot of it? How do you regulate dosage of any of these things? This sounds about as smart as giving all cows antibiotics ... because that's been such a smart move on the part of our country.

Can you please provide the source of your states re: diagnosable psychiatric illness and paranoid delusions? I'm curious about that, especially since even the patient advocacy groups out there state that about 1-1.5 percent of the U.S. population suffer from paranoid delusions. That's a far cry from 10 percent.

PTSD associated Paranoia. Imagine they are back in the battle field and everyone is trying to kill them.

Religious Zealotry Induced Paranoia. Read Muslim web sites talking about 9/11 being caused by a Jewish Cabal which frames innocent Muslims. And how the Koran and Islam are being unfairly prosecuted by the West. And no terror was ever caused by Islam.
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Paranoia delusions are common. Read any web thread and you can see abnormality. Fruity amusing ones are on JFK assassination, Hitler, and 9/11 conspiracy sites.

We are all a little paranoid.
It is a spectrum.
But when it interferes with the ability to see REALITY and to function normally in society, then it is dysfunctional.

Of course we could easily increase life expectancy if we are willing to compromise on our individual liberties, but next to no one is willing to do that.

Ask the vast, vast majorities of American citizens if they would be willing to lose the freedom you mention in exchange for 6-7 more (likely crappy) years at the end of their lives, and they will say no.

What you are describing is not an issue of paranoia, but of intelligence levels combined with a willingness to accept an argument because it supports your interpretation of the world around you. This entire spectrum of people you want to medicate will not benefit from an SSRI because the issue is not chemical. It is cognitive. Instead of medicating everyone, perhaps we should teach them better critical thinking skills.

> It is due to widespread use of effective anticholesterol drugs
> known as ‘statins.’ ie. Lipitor.

The first statin, lovastsatin (Mevacor), came to a market in 1987. Atorvastatin (Lipitor) became available in 1997. Heart disease has been on decline well before statin use became widespread. The impact of statins on reduction of mortality since 1997 is difficult to assess because of rather conflicting results from different studies.

> High cholesterol is endemic and contributes to strokes and heart
> attacks.

Sure. But studies from 2012 also point out that while patients on statins are less likely to die from heart attack, the overall mortality between statin-treated and untreated heart-disease patients are rather similar.

> Just about everyone benefits from lower cholesterol.

"Statins do not have a proven net health benefit in primary prevention populations ..." in Therapeutics Letter Issue 77, 2010.

Part of the problem does seem to be economic involving individuals displaying unbridled capitalism, i.e. greed. However, perhaps a more basic and insidious problem stems from contemporary US culture with its strong emphasis on individualism and its comparative lack of concern with the wider community.

There is nothing wrong with US culture that less restrictive regulation wouldn't control. Govt meddling into healthcare to make it fair is the problem. By forcing insurers not to penalize people for their health, you allow them to make the same stupid choices of living. US individualism has made this country great, and mindless conformity liberals want reduces innovation.

This administration has added so much regulation with Obamacare and FinReg it has put a strangle hold on business. As usual you take the liberal tact of mentioning extremes. Yes business must have regulation but the amount we have now is damaging the economy. All Democrats do is add regulation. When have you heard them dropping a regulation or law? Our businesses are being regulated to death. Individualism leads to innovation, and economic growth. Conformity alone doesn't allow thinking outside the box. A happy medium of both would be nice but the US government is intent on killing individualism because Democrats want to control. Liberals and Democrats are always surprised when someone has an opinion that differs from theirs. As much as they talk about freedom, liberals think their ideas only have merit.

You are ignoring the issue. America pays far, far more for medical care than other countries and has poorer results. If you had a medical system as cheap and effective as Canada's (neither the cheapest nor the most effective on the list above), your economy would have an extra $1.7 trillion dollars to throw around each year, and life expectancies would be 3 years longer. Amid the bickering over whether to have public or private healthcare, America has settled on both, with both massive private spending and massive public spending (incredible as it seems, the US government alone spends more per capita on health than Canada's does).

Free-markets are meant to make things more efficient, and most of the time they do. But the mishmash of public-private involvement in the US medical system has done the opposite, and I think any reasonably pragmatic person on either side of the aisle would recognize something needs fixing, and I think you, and your country, could do with less dogma and more practicality when it comes to medical care. I agree Obamacare doesn't really address the issue of costs, but I don't think most of your proposals would either.

So by your argument if someone has survived breast cancer and the insurance companies refuse to insure her, it is somehow her fault ?

You are basing your judgement on the incorrect assumption that we have unrestricted free will. A simple strole through any place where humans live will confirm that limited free will is the best we can get.

There are serious ethical and practical issues of both supply and demand that have to be addressed before talk of funding means anything at all. Until we get through that hard political work, there is no intelligent way to allocate the pain of getting the cost of medical care under control.

The problem we face is the rate of increase of that cost. It doesn't matter who is paying; it will bankrupt the country. It seems to me that too many people forget that the public and private sectors are parts of the same economy.

We have to reorganize how health care is provided and paid for. Shifting the cost without decreasing it is pointless.

Health care costs in the US suffer from two basic practices. First, reliance on private insurance and the willingness of insurers to cover reasonable costs is simply misplaced. Insurers are regulated by states, most of which do not have the resources to review insurance company rate change requests. The result is too much reliance on rate of return regulation – allowing, say, 11% above expenses. Insurers under that form of regulation invariably pad their expenses to generate a higher 11%

Second, patient data access and retrieval is primitive at best, with the majority of records kept as hard copy in old fashioned folders that take up space and limit the distribution of critical information when and where the patient needs it. The trend toward maintaining the data in centralized (i.e. remote) data banks is inefficient, compared with allowing a patient to carry his/her records on something as simple as an SD flash card the size of a postage stamp, which would hold more than 10 years of records and x-ray images for the average patient.

These two factors result in health care administrative costs running about four times the costs in countries such as Canada and the Netherlands, documented by studies published in the Journal of the American Medical Association. Given the influential power of insurance companies, change will be difficult.

In the US relatively less is spent on preventative care (including education) than in many other countries, in part related to a lack of insurance coverage. Hence more people get more seriously ill which cost more in the end to treat than it would have costs to prevent.

The Danes are nothing compared to the Dutch. Many have two bicycles, one for home to the train station and one from the train station to work. Looking at the bicycle parking at the train station in Utrecht, a main city, I estimated a 1000 bicycles.

Not really what I was talking about though. I agree the Dutch may have started the bicycling movement but the Danes definitely perfected it.

The infrastructure and planning of bicycle lanes in Copenhagen particularly is beyond that of Amsterdam or any other Dutch city I have visited. In Denmark, the efficiency means you only need one bicycle... the trains have specific bike areas :)

You are missing the point. Amsterdam is for bicycles and when you get in the way with your car, you get these strange scratches on your car and the police does not care.
The Dutch are also allowed to take the bike in the train, however it is a pain to lug the damn thing onto the platform. Easier to steal another bike for the second part of your journey. Last but not least, there are 16.7 million Dutchmen and only 4 million Danes, who are all concentrated in Copenhagen. The Dutch bike everywhere.
Watch your right hand turns.

The issues in Denmark are quite severe in fact:
1. They still are smoking quite a lot
2. Alcohol consumption is high, they do not have severe restrictions on access like their northern brethren in Norway, Sweden and Finland.
3. Traditional food is meaty, fatty and lots of it.
All this is changing of course but Danes are relaxed and not fanatically adopting strict health rules.
By the way, biking in Denmark (and even more in the Netherlands) has one hidden agenda: it saves money. These people are known as money pinchers!

Mr. Pfeffer, yes you do not understand the Dutch soul and the position of the bikes in The Netherlands. For starters there are 16.5 million Dutchmen and they are concentrated (10 million) in the west in an area similar in size as Denmark. They do not need raised bike paths, they take the road. A car gets scratched when he is in the way.

Medicine in the US is an industry people pursue to get rich, just like law and finance. Is it the same elsewhere for MDs?

I have a hard time getting my head around the idea that the US medical/insurance/legal industry will allow that 17.9% figure to do anything but grow. Too many people feast off of it for any pol to dare to try to reduce it.

Do you know in Japan, doctors have to put vending machines in their offices to make enough money because government payments are so low. Switzerland controls the costs. They allow private insurers to offer a basic policy to cover most costs to all and a more expensive premium policy to cover more costs. They make a profits on the premium policies. The US is pursuing the UK model which has been a failure, and allows bureaucrats to decide cots effective treatments. Doctors are no longer in charge. Obamacare is destroying our good system of medicine.

The phrase "good system of US medicine" is an oxymoron as the charts show.

Basically you don't want a change from the status quo in the USA. That's cool, maybe you are young fit and rich and don't need the pols determining your insurance for you. Its ok to argue on that basis.

However you are arguing on the basis that the other helath systems are "worse" than ours, which the facts from the study inconveniently (for you) show is not the case.

Last month, in The Netherlands, a major newspaper reported that 75% of the Dutch primary care doctors does not want to run an independent practice. (I do have to say, the medical care is too high there and from talking to a few members of my family, they are not happy with the medical system in their country).